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Recommendations to consider postponing all but essential travel to these regions of China were issued on 23 April and 8 May in order to minimize the international spread of SARS. WHO is changing this recommendation as the situation in these areas has now improved significantly. Information about the decline of the outbreaks in Hebei, Inner Mongolia, Shanxi and Tianjin has been carefully reviewed by WHO and suggests that SARS is no longer a potential threat to international travelers to these regions. In addition, WHO is removing Guangdong, Hebei, Hubei, Inner Mongolia, Jilin, Jiangsu, Shaanxi, Shanxi and Tianjin from the list of areas with recent local transmission. This follows confirmation that there have been no new cases isolated in any of these areas for more than twice the maximum incubation period, in other words more than 20 days. On 27 March, WHO recommended that areas with recent local transmission should screen all international departing passengers to ensure that those who are sick with SARS or are contacts of SARS cases do not travel. This recommendation is still valid for Beijing, Hong Kong and Taiwan in China, and Toronto, Canada. China has mad a massive effort to mobilize the population both in urban and rural areas across the country, encouraging people to monitor themselves for fever and to ensure that SARS cases are quickly identified, isolated and treated has been, according to WHO.
May 10, 2003 85 new probable cases today, including 54 new cases in Beijing, and 5 new deaths. China now has a cumulative total of 4,884 probable cases, with 235 deaths. Beijing remains the most severely affected area in mainland China, with a cumulative total of 2,227 probable cases and 116 deaths. Since the beginning of this month, Beijing has reported 862 new probable cases and 41 deaths. The largest number of cases for this month occurred on 1 May, when Beijing reported 122 new cases and 7 deaths. Although today's figures are lower, WHO officials in Beijing have cautioned against any clear conclusions that the SARS outbreak has begun to decline in the city. Many factors that influence the outbreak's future evolution remain unknown. For example, half of all new probable cases in the city do not have any recorded previous contact with a SARS patient. Knowledge about the source of transmission for all SARS cases contributes to understanding of the dynamics of the outbreak and assists in its containment. WHO officials will be working with Beijing authorities to improve data analysis and develop policy options for responding to the outbreak. The lack of known contact to a SARS patient among the more recently reported cases could be related to either how cases are being reported or how and where the virus is being transmitted. May 9, 2003 118 new probable SARS cases and 6 new deaths reported, bringing the cumulative totals to 4,805 probable cases and 230 deaths. Bejing reported 48 new cases and 2 new deaths, Inner Mongolia reported 20 new cases and 1 new death, Shanxi reported 11 new cases, and Hebei reported 9 new cases and 2 deaths. The additional death was reported in Tianjin. Yesterday (May 8), a WHO team traveled to Hebei Province, which borders Beijing municipality, to assess the SARS situation. The WHO investigation is being conducted in collaboration with the Ministry of Health and marks the first time that a joint WHO-Ministry of Health team has been sent to a province. WHO has expressed concern that Hebei could be particularly vulnerable to the spread of SARS, as the province has a large population of migrant workers - part of Beijing's "floating population". The investigation in Hebei has two objectives: to review the surveillance and case reporting systems, and to visit hospitals to asses procedures for patient management and infection control. In several outbreaks elsewhere, lapses in infection control have resulted in the infection of large number of hospital staff. May 6, 2003 China reported 138 new probable SARS cases today, 70 of which were from Beijing, bringing the cumulative total in the country and capital to 4409 and 1960 respectively. There were also 8 deaths reported, half from Beijing, bringing the total number of SARS deaths to 214. New probable SARS cases were also reported in Guangdong (12), Hebei (6), Inner Mongolia (21), Jilin (2) and Tianjin (11). The number of cases in Jilin has increased in the last few days, with cases tripling tos 23 since April 30. There were also two new cases in Shanghai, bringing the city's total number of cases to six. Cases continued to rise in the two most heavily affected provinces outside of the capital, Shanxi and Inner Mongolia, with 11 and 21 probable cases reported, for a total of 369 and 251 respectively. Four WHO experts will leave on 8 May with experts from China's Ministry of Health for the Hebei province, which surrounds Beijing and is home to some of the capital's "floating population" of migrant workers. Their goal is to assess the SARS situation and the capacity to cope with the outbreak. The number of probable SARS cases in Hebei has risen sharply in the last few days to a total of 113, as of today. In just five days between April 30 and May 4, the numbers doubled to 98. There are also about 100 suspect SARS cases in the province. May 5, 2003 Chinese authorities reported 160 new probable cases of SARS and 9 new deaths. The new figures bring the cumulative total in China to 4280 probable cases and 206 deaths. Of the new cases, 98 were reported in Beijing. The second highest number of new cases was reported in Shanxi. Three of the 9 deaths occurred in Beijing, 3 in Guangdong, 2 in Shanxi, and 1 in Tianjin. The new figures bring the cumulative total in China to 4,280 probable cases and 206 deaths. China now accounts for 65% of the world's total cumulative number of probable SARS cases and 44% of all reported deaths. In Beijing, some 16,000 residents remain under quarantine. In Taiyuan, the capital of Shanxi Province, where 360 probable SARS cases have been reported, all schools are to be closed indefinitely. WHO officials are particularly concerned about the SARS situation in China's outer provinces, where surveillance and reporting systems may not be sufficiently sensitive to detect all suspect and probable cases. In resource-poor regions like Gansu and Jiangxi, serious questions remain about the capacity of the health systems to cope with a challenge on the scale of SARS. May 2, 2003 China reported 176 new probable SARS cases today, 96 of which were in Beijing. These numbers bring the cumulative total in China to 3799 and 1636 in the capital. Eleven deaths were reported, accounting for a cumulative total of 181 deaths. Inner Mongolia reported a jump of 26 in probable SARS cases, for a total of 180 cases in that province. Other provinces reporting new cases include Hebei (14), Guangdong (9), Jilin (5) and Shanxi (4). A WHO field visit to one large hospital not officially designated as a SARS hospital demonstrated the urgent need to review strategies for infection control procedures. Current infection control practices in emergency rooms may need to be modified, since health care workers continue to be infected. Among front-line health workers, 15 new cases were reported in Beijing. There are now 300 infected health care workers. 9 more cases among health workers were also reported in Tianjin. WHO team members in Beijing continue working with officials from the city's municipal health authorities to analyze epidemiological trends, but much missing data remain to be collected, and reports from case investigations must still be completed. "The public needs to have more information on when and where infection is happening," said Dr Henk Bekedam, WHO's representative in China. "We don't know that right now." May 1 The number of new SARS cases continues to increase steadily in China, particularly in Beijing. Today, China reported 187 new cases and 11 deaths, more than half of which were in the capital. WHO officials in China believe the development of a central database of operational SARS data would greatly aid in combating the disease. The next few months will prove crucial in the attempt to contain SARS worldwide, which now greatly depends on whether the disease can be controlled in China. WHO is studying how best to support hospitals in some of China's poorer western and northern provinces. Concern continues that hospitals in these resource-poor regions may not have the necessary facilities to properly isolate and treat SARS patients. More front-line hospital staff with expertise in dealing with infectious diseases may be required. Guidelines are also needed for China's national health care system on the kinds of infection control measures needed to prevent continuing transmission of the disease. Shanghai is to enforce stricter SARS preventive measures, including the enforcement of 14-day quarantine periods for travelers arriving from affected areas. These measures are even stricter than those currently recommended by WHO. Traffic checkpoints have already been set up to screen people coming into the city, where they are given temperature checks and asked to fill out health declaration forms. April 17: Chinese authorities have today reported 12 new cases of SARS. Nine new cases were reported from Guangdong Province, and one each in Inner Mongolia and Sichuan Province. Ningxia, a poor province in the remote western part of the country, announced its first case today. Beijing reported no new cases and no new deaths. Today's figures do not include cases in Beijing's military hospitals. The military hospitals, which are not obliged by Chinese law to report cases to health authorities, have been the focus of considerable rumors over the past several days. A WHO team began visits to Beijing's military hospitals yesterday. The recent decision of military hospitals in Guangdong Province to report SARS cases to the authorities may set an important precedent. WHO staff in China have been further encouraged by the presence of national surveillance and reporting teams in provinces that are now reporting cases. The presence of national SARS teams actively searching for cases is a welcome sign that the severity of the SARS threat is being taken seriously by the government. An additional WHO team will be traveling to Shanghai next week. April 7: The Chinese Ministry of Health is now providing daily updates on numbers of cases and deaths, nationwide by province. On 3 April, a total of 17 new cases, including two deaths, were reported. Two previously reported cases were excluded. Eleven new cases and one death occurred in Guangdong Province. One case was reported from Shanghai, four from Beijing, and one case (fatal) from Sichuan Province. On April 4, 12 new cases, with no deaths, were reported, 11 from Guangdong and 1 from Shanxi. For April 5 and 6, 21 new cases and 2 new deaths were reported. The breakdown by province is awaiting translation from Chinese. This brings the total number of reported cases in China to 1268, with 53 deaths. Chinese officials have announced that SARS is being made a high priority for the government. A system of alert and response for early detection and reporting of all emerging and epidemic-prone diseases is being put in place. The government has also begun holding daily press conferences. WHO welcomes this move, which is an important way to increase awareness of the population and health care staff of the characteristic symptoms, the need to seek prompt medical attention, and the need to manage patients according to the principles of isolation and strict infection control. The WHO office in China has reported considerable anxiety among the international community following the death in Beijing on Sunday of a 53-year-old Finnish staff member of the International Labor Organization (ILO). The ILO staff member was in Beijing to attend an international conference. At present it is unclear how the staff member contracted SARS. He had traveled to Beijing via Thailand, where no local transmission has been reported. April 1: The World Economic Forum has postponed a meeting of business and government leaders in Beijing set for April 14-15 until fall because participants were concerned about a deadly new flu-like disease.
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